Application for reimbursement of normal reimbursement ratio of medical insurance

According to the relevant laws and regulations of our country, employees should pay basic medical insurance, which is generally paid by both employers and employees. Only when certain conditions are met can they enjoy basic medical insurance benefits.

What is the reimbursement rate of medical insurance?

First, the proportion of outpatient reimbursement

(1) Employee medical insurance:

1.1Medical expenses above 800 yuan can only be reimbursed after on-the-job employees go to the hospital for emergency treatment. The reimbursement rate of community hospitals is 90%, and that of other designated hospitals is 70%, with a maximum reimbursement of 20,000 yuan.

2. For retirees under 70 years old, the expenses above 1.300 yuan can be reimbursed, and the reimbursement ratio is 85% (non-community hospitals) and 90% (community hospitals).

3. Retirees over 70 years old, 1300 yuan, can be reimbursed by 90% regardless of the hospital.

4. No matter what kind of people, the maximum payment for outpatient and emergency medical expenses is 20,000 yuan.

② College students:

1, 35% for the part with insufficient medical expenses 1000 yuan;

2, medical expenses in 654.38+ten thousand yuan (including 654.38+ten thousand yuan) above, less than 5000 yuan, 45% reimbursement;

3, medical expenses in more than 5000 yuan (including 5000 yuan), less than 10000 yuan, 55% reimbursement;

4, medical expenses in 1 ten thousand yuan (including 1 ten thousand yuan) above, reimbursement of 65%.

Second, employee medical insurance: the proportion of reimbursement for hospitalization expenses

1, Qifubiaozhun: within a medical insurance year, the Qifubiaozhun for the first hospitalization is 1300 yuan, and the Qifubiaozhun for the second and subsequent hospitalization is 650 yuan.

2. Reimbursement proportion: the payment proportion is calculated according to the hospital grade by subsection calculation and cumulative payment.

3. Payment limit: the cumulative maximum payment limit of the basic medical insurance pooling fund within one year is 654.38+10,000 yuan, and the cumulative maximum payment limit of large mutual aid funds is 200,000 yuan and * * * 300,000 yuan.

The law provides that:

Article 29 of the Social Insurance Law of People's Republic of China (PRC) stipulates: "The part of the medical expenses incurred by the insured that should be paid by the basic medical insurance fund shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.

Legal objectivity:

"People's Republic of China (PRC) Social Insurance Law" Article 29 The part of the medical expenses incurred by the insured that should be paid by the basic medical insurance fund shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits. Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses, and shall be paid from the basic medical insurance fund in accordance with state regulations.